Anticonvulsants before 1993
| Generic (Brand name) Abbreviation |
Oral Formulations Usual adult dose (Therapeutic level if available) |
Quick notes | ||||||||||
| Carbamazepine (Tegretol, Tegretol XR ) CBZ |
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T 1/2: 11-24 hr Prot binding: 75% Metabolism: hepatic Mechanism: Na channel blocker Therapeutic range: 4-12 ug/ml |
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| Carbamazepine (Carbatrol) |
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| Clonazepam (Klonopin) CZP |
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T 1/2: 18-50 hours Metabolism: hepatic Tolerance to antiepileptic effect may develop up to 30% of patients. |
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| Ethosuximide (Zarontin) ESM |
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T 1/2 adult: 50-60 hour Metabolism: 20% excreted renal, 65% hepatic. |
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| Phenobarbital PHB |
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T 1/2: 96 hr Prot binding: 40% Metabolism: hepatic Mechanism: GABA receptor agonist |
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| Phenytoin (Dilantin) PHT |
Susp: 125mg/5ml, Cap: 30, 100mg Dose: 200-500 mg/day qd to bid (level: 10-20 ug/ml) |
T 1/2: 22 hr Prot binding: 90% Metabolism: hepatic Mechanism: Na channel blocker |
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| Primidone (Mysoline) |
Susp: 250mg/5ml, Tablet: 50,250mg Dose: 250-1500mg/day bid to tid (level: Primidone 5-13 ug/ml, Phenobarb 10-40ug / ml) |
T 1/2: 6-8 hr Prot binding: 70% Metabolism: hepatic to PEMA & phenobarbital Mechanism: GABA receptor agonist |
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| Valproic acid (Depakene, Dapakote) VPA |
Susp: 250mg/5ml, Tab: 125, 250, 500mg, Sprinkle cap: 125 mg Dose: 375-3000 mg/day, given bid to tid (level: 50-100 ug/ml) |
T 1/2: 8-16 hr Prot binding: 90% Metabolism: hepatic Mechanism: Na channel blocker |
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* Approximate
** Active metabolite Phenobarbital has half life of 96 hours
Side effects of Anticonvulsants
| Medication | Common side effect (usually dose dependent) |
Uncommon but serious side effect, idiosyncratic |
| Carbamazepine | Drowsiness, ataxia, leukopenia | Rash, hyponatremia, aplastic anemia, hepatitis, pancreatitis |
| Felbamate | Insomnia, weight loss, headache, decreased appetite | Aplastic anemia: present average 154 days after
therapy, risk: 1:4000 to 5000 Risk of fatal hepatotoxic effect 1:26,000 to 34,000 |
| Gabapentin | drowsiness, fatigue, dizziness and possible movement disorder | none recognized |
| Gabatril | dizzy, nervous, tremor, abdominal pain | none recognized |
| Lamotrigine | Rash (up to 10%, may be related to fast titration), drowsiness, nausea | none recognized |
| Phenobarbital Primidone |
Hyperactivity in children, drowsiness, slowing of cognitive functions, ataxia | Rash, Stevens-Johnson syn, depression |
| Phenytoin | drowsiness, nystagmus, ataxia, gingival hypertrophy | Rash, hepatitis, hirsutism, peripheral neuropathy? |
| Topiramate | tiredness, dizzy, ataxia, drowsy, nervous, psychomotor slowing | kidney stone, 1.5% |
| Valproic acid | tremor, thrombo-cytopenia, weight gain | hair loss, hepatitis, pancreatitis |
Carbamazepine
 | Drugs that inhibit CYP 3A4 and increase Carbamazepine level
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| Drugs that induce CYP3A4 and reduce Carbamazepine level
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Further reading
| Choice of anticonvulsant in different type of seizures - BMJ Jan 99 |
| Review of Epilepsy treatment - BMJ Jan 99 |
| Back to Epilepsy information center |
| Dosage for status Epilepticus |